1. Sérgio Kwitko, Tiago Lansini, Andressa P Stolz, Diane R Marinho Authors have no financial interest in the subject matter of this poster

2.  In cases of multiple corneal transplants, each new corneal graft increases the risks of rejection and complications such as glaucoma and macular edema, while the average time of graft survival decreases.  Ma JJK, Graney JM, Dohlman CH. Repeat penetrating keratoplasty versus the Boston keratoprosthesis in graft failure. Int Ophthalmol Clin [Internet]. 2005 Jan [cited 2015 Jan 2];45(4):49–59. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16199966  The Kpro has been an important alternative in cases of corneal blindness in which penetrating corneal transplantation does not have a good prognosis.  Aquavella J V, Qian Y, McCormick GJ, Palakuru JR. Keratoprosthesis: the Dohlman- Doane device. Am J Ophthalmol [Internet]. 2005 Dec [cited 2015 Jan 2];140(6):1032– 8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16376647  The purpose of our study was to evaluate the outcomes and complications of the Boston KPro in a retrospective case series from a single center, who all received similar surgical treatment and KPro technology.

3.  A retrospective case series was performed on all patients undergoing Boston KPro implantation at Hospital de Clinicas de Porto Alegre performed between September 2005 and August 2014. A minimum follow-up of 6 months was required. Using a computerized patient database, 35 eyes of 29 patients were identified that met these criteria.  Boston KPro implantation was performed via the standard technique.  Dohlman CH, Abad JC, Dudenhoefer EJ et al. Ophthalmic Surgery: principles and practice. 3rd ed. Philadelphia, PA: W. B. Saunders; 2002.

4.  Patients were examined postoperatively on the first day, first week, 2 weeks, and first month after surgery. If stable, the patients were followed every month.  Best-corrected visual acuity (BCVA), complications and retention time of KPro were evaluated during the follow-up period.

5. Patients  Thirty-five eyes of 29 patients were studied. No patients were lost to follow-up before 6 months. Mean follow up was 56.13 months (6 to 96 months). The Boston KPro was implanted in 20 right eyes and 15 left eyes. There were 13 females and 22 males.  There were no significant differences on eyes involved or sex. Mean patient age at the time of KPro implantation was 47 years-old (range, 13 to 81 years-old SD=48,08) for all patients;

6. TABLE 1. Original Diagnoses Original Diagnosis No. Eyes (%) Failure of multiple previous corneal transplants*17 (48,57) Chemical burn11 (31,42) SJS 3 (8,57) graft versus host disease2 (5,71) Aniridia1 (2,85) Thermal burn1 (2,85) *keratoconus, bullous keratopathy, congenital glaucoma, angle-closure glaucoma, Fuchs dystrophy, and Acanthamoeba keratitis Results TABLE 2. Preexisting Comorbidities Preexisting Comorbidities No. Cases (%) Glaucoma 14 (40) Limbal stem cell deficiency 14 (40) Tube shunt 4 (11,42) Retinal Detachment2 (5,71) Aniridia 1 (2,85)

7. TABLE 3. Concomitant Procedures Concomitant Procedures No Eyes (%) Cataract extraction/intraocular lens insertion 13(37,14) lid reconstruction 11(31,42) conjunctival fornix reconstruction9(25,71) Tube shunt 5 (14,28) salivary gland transplantation6 (17,14) Results TABLE 4. Postoperative Complications Complications Eyes (%) Increased intraocular pressure 17 (48,57) cystoid macular edema 10(28,57) Corneal necrosis8 (28,85) Viteritis7(20) None5(14,28) Retroprosthetic membrane 5 (14,28) Fungal Keratitis 5 (14,28) Glaucoma progression4(11,42) Retinal Detachment3(8,57) Endophthalmitis 2 (5,71) Coroidal detachment2(5,71)

8.  In conclusion, our cases series suggests that the KPro is a promising alternative for high risk PKP patients, and seems to be a viable option specially in cases of alkali burn and multiple previous PKP failures. One main advantage of the Boston KPro is no need of systemic immunosuppression. However, vision-threatening complications continue to be a major problem of this procedure, specially in a long-term follow-up.